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International Journal of Surgery Case... May 2022Esophageal achalasia is a motility disorder of the esophagus with unknown etiology characterized by the failure of lower esophageal sphincter relaxation. Diagnosis is...
INTRODUCTION AND IMPORTANCE
Esophageal achalasia is a motility disorder of the esophagus with unknown etiology characterized by the failure of lower esophageal sphincter relaxation. Diagnosis is made by barium esophagography, endoscopy, and esophageal manometery. Heller Esophagomyotomy along with Dor's fundoplication is the treatment of choice. Persisting undiagnosed cases may lead to malnutrition.
CASE PRESENTATION
We present a case of an 8-year-old child suffering from dysphagia and regurgitation. The child was misdiagnosed and maltreated for the suspicion of respiratory tract and gastrointestinal problems in the local clinics. During this time, he remained unresponsive to the mentioned treatments, and the local physician advised him to have an upper gastrointestinal (GI) endoscopy, which revealed esophageal achalasia (EA). On admission to our pediatric surgery ward, the patient had coexistent parotitis, which was treated conservatively. Following recovery, the patient was prepared for surgery and underwent esophageal myotomy along with Dor's fundoplication.
CLINICAL DISCUSSION
Esophageal achalasia is rare in children, but poses major health challenges to children if left untreated. Symptomatic treatment may mask the actual picture of the problem and last for years. Following surgery and discharge from the hospital in a three-month follow-up interval of time, our patient exhibited full recovery, with gaining 4 kg weight.
CONCLUSIONS
Respiratory and gastrointestinal conditions with similar signs and symptoms should always be considered in differential diagnosis of esophageal achalasia, especially where there is no direct access to a pediatric specialized complex. On-time evaluation and treatment will further prevent children from malnutrition in long-lasting undiagnosed patients.
PubMed: 35658288
DOI: 10.1016/j.ijscr.2022.107112 -
BMJ Case Reports Nov 2021
Topics: Humans; Meningitis, Viral; Meningoencephalitis; Mumps
PubMed: 34764134
DOI: 10.1136/bcr-2021-247306 -
Cureus Jan 2021Symptoms of dry eyes or dry mouth, otherwise known as sicca symptoms, are not always present in patients with Sjögren's syndrome (SS). Approximately 20% of patients...
Symptoms of dry eyes or dry mouth, otherwise known as sicca symptoms, are not always present in patients with Sjögren's syndrome (SS). Approximately 20% of patients with SS do not have sicca symptoms. An unusual case of a patient presenting with complete left-sided facial hemiparesis, a history of partial bilateral sensorineural hearing loss who was found to have elevated antinuclear antibody (ANA) with high titer positive SSA/Ro antibody, evidence of bilateral parotitis on imaging and absence of sicca symptoms, prompted us to perform a literature review. Twelve case reports relating facial nerve palsy and Sjögren's were found and only one described a similar constellation of features of unilateral facial weakness and otalgia. Management of facial nerve palsy related to Sjögren's is unclear but pharmacological agents have included corticosteroids, intravenous immune globulin (IVIG), cyclophosphamide, and plasmapheresis. This case report describes a patient whose facial nerve palsy is attributed to SS, explores peripheral and central nervous system involvement in SS, and provides some recommended treatments.
PubMed: 33659130
DOI: 10.7759/cureus.12996 -
BMJ Case Reports Feb 2021
Topics: Bell Palsy; Facial Nerve; Facial Paralysis; Humans; Parotitis
PubMed: 33541969
DOI: 10.1136/bcr-2020-241001 -
Epidemiology and Infection Feb 2023The resurgence and outbreaks of mumps occur frequently in many countries worldwide in recent years, even in countries with high vaccination coverage. In this study, a...
The resurgence and outbreaks of mumps occur frequently in many countries worldwide in recent years, even in countries with high vaccination coverage. In this study, a descriptive and spatiotemporal clustering analysis at the township level was conducted to explore the dynamic spatiotemporal aggregation and epidemiological characteristics of mumps in Wuhan. During 2005 and 2019, there were 40 685 cases reported in Wuhan, with an average annual morbidity of 28.11 per 100 000 populations. The morbidity showed a fluctuating tendency, and peaked in 2010 and 2018. Bimodal seasonality was found, with a large peak between May and July, and a mild peak from November to January in the following year. Male students aged 5-9-year-old were the main risk group of mumps infection. Significant global spatial auto-correlation was detected except in 2007, 2009 and 2015. The spatial and temporal scan statistics indicated that the hot-spots mainly located at the western and southern areas of Wuhan with variations almost every year. Our findings could assist the public health authorities to develop and improve targeted health strategies, and allocate health resources rationally.
Topics: Humans; Male; Child, Preschool; Child; Mumps; Incidence; Spatio-Temporal Analysis; Disease Outbreaks; China
PubMed: 37114752
DOI: 10.1017/S0950268823000304 -
American Journal of Preventive Medicine Mar 2022Parental vaccine hesitancy can be a barrier to routine childhood immunization and contribute to greater risk for vaccine-preventable diseases. This study examines the...
Parental Vaccine Hesitancy and Association With Childhood Diphtheria, Tetanus Toxoid, and Acellular Pertussis; Measles, Mumps, and Rubella; Rotavirus; and Combined 7-Series Vaccination.
INTRODUCTION
Parental vaccine hesitancy can be a barrier to routine childhood immunization and contribute to greater risk for vaccine-preventable diseases. This study examines the impact of parental vaccine hesitancy on childhood vaccination rates.
METHODS
This study assessed the association of parental vaccine hesitancy on child vaccination coverage with ≥4 doses of diphtheria, tetanus toxoid, and acellular pertussis vaccine; ≥1 dose of measles, mumps, and rubella vaccine; up-to-date rotavirus vaccine; and combined 7-vaccine series coverage for a sample of children aged 19-35 months using data from the 2018 and 2019 National Immunization Survey-Child (N=7,645). Adjusted differences in multivariable analyses of vaccination coverage were estimated among vaccine hesitant and nonhesitant parents and population attributable risk fraction of hesitancy on undervaccination, defined as not being up to date for each vaccine.
RESULTS
Almost a quarter of parents reported being vaccine hesitant, with the highest proportion of vaccine hesitancy among parents of children who are non-Hispanic Black (37.0%) or Hispanic (30.1%), mothers with a high school education or less (31.9%), and households living below the poverty level (35.6%). Childhood vaccination coverage for all vaccines was lower for children of hesitant than nonhesitant parents, and the population attributable fraction of hesitancy on undervaccination ranged from 15% to 25%, with the highest percentage for ≥1 dose of measles, mumps, and rubella vaccine.
CONCLUSIONS
Parental vaccine hesitancy may contribute up to 25% of undervaccination among children aged 19-35 months. Implementation of strategies to address parental vaccine hesitancy is needed to improve vaccination coverage for children and minimize their risk of vaccine-preventable diseases.
Topics: Child, Preschool; Diphtheria; Humans; Infant; Measles; Measles Vaccine; Measles-Mumps-Rubella Vaccine; Mumps; Parents; Pertussis Vaccine; Rotavirus; Rubella; Tetanus Toxoid; Vaccination; Vaccination Hesitancy; Whooping Cough
PubMed: 35190101
DOI: 10.1016/j.amepre.2021.08.015 -
Human Vaccines & Immunotherapeutics Dec 2022Despite the introduction of the trivalent vaccine (measles, mumps, rubella) more than 20 years ago, measles outbreaks have occurred in Europe, including Italy, due to...
Despite the introduction of the trivalent vaccine (measles, mumps, rubella) more than 20 years ago, measles outbreaks have occurred in Europe, including Italy, due to its underutilization. In Italy mandatory vaccination was established in 2017 (Decree Law 119/2017). This study aimed at evaluating the impact of mandatory vaccination and determining the trend in vaccination coverage for measles and rubella in Italy. We retrieved data from the Annual Status Update, a form sent annually by the Italian National Verification Committee to the Regional Verification Committee for Europe, from 1 January 2013 to 31 December 2019. Since the beginning of 2013, 14,788 cases of measles have been reported, ranging from 256 (3.9 x 1,000,000) to 5,397 (88.4 x 1,000,000) compared to 259 rubella cases for the same period. From 2013 to 2015, vaccination coverage decreased for the first dose of measles (90.4% to 85.3%) and rubella vaccine (90.3% to 85.2%), but then it increased significantly, reinforced by the Italian Decree Law, reaching 94.4% in 2019. The trend for the second dose showed a decrease from 2013 to 2016 (84.1% to 82.2% for measles and 83.7% to 82.0% for rubella), but then increased significantly and reached 90.2% in 2019 for measles and 90.0% for rubella. The mandatory vaccination law has resulted in a significant increase in vaccination coverage for measles and rubella in Italy, and demonstrates encouraging progress toward the 95% target and the restriction of measles transmission. Special attention should be paid to maintaining and further improving vaccination coverage.
Topics: Humans; Incidence; Italy; Measles; Measles-Mumps-Rubella Vaccine; Mumps; Rubella; Vaccination; Vaccination Coverage
PubMed: 34346840
DOI: 10.1080/21645515.2021.1950505 -
International Journal of Infectious... Jan 2022By 2017, rubella had been officially eliminated in Australia. This success was attributed to Australia's longstanding national immunization programme and two enhanced...
BACKGROUND
By 2017, rubella had been officially eliminated in Australia. This success was attributed to Australia's longstanding national immunization programme and two enhanced measles immunization activities using measles, mumps, and rubella (MMR) vaccines - the Measles Control Campaign (MCC) and the Young Adult MMR Campaign (YAC). Our study describes the impact of these activities on rubella incidence, and its elimination in Australia.
METHODS
Aggregate national serological survey data were assigned to birth cohorts, and mean, median, and age-group estimates calculated and analyzed against MMR immunization coverage estimates (1998-2018) and rubella notifications (1993-2018). Three-year cumulative incidences were calculated by birth cohort.
RESULTS
The serological surveys revealed high and stable levels of rubella immunity among females, but estimates for three male cohorts were lower. Since 2007, MMR immunization coverage among children aged 24-27 months has remained above 90% for both doses. The 3-year cumulative incidence of rubella declined across all birth cohorts following the MCC and the YAC.
DISCUSSION
Using MMR vaccines to address measles immunity gaps had the additional benefit of controlling rubella in Australia. Both the MCC and YAC shifted rubella epidemiology, accelerating the interruption of endemic transmission. Countries should consider combined measles and rubella vaccines for all catch-up activities.
Topics: Antibodies, Viral; Australia; Birth Cohort; Catalysis; Child; Female; Humans; Male; Measles; Measles-Mumps-Rubella Vaccine; Mumps; Rubella; Young Adult
PubMed: 34749012
DOI: 10.1016/j.ijid.2021.11.003 -
Minerva Medica Aug 2023
Topics: Humans; Parotitis; Foreign Bodies; Acute Disease
PubMed: 35332755
DOI: 10.23736/S0026-4806.21.07827-7 -
Frontiers in Immunology 2021The aim of this study was to evaluate the clinical validity of early Sjögren's syndrome (SS) autoantibodies (eSjA), which were originally marketed for early diagnosis... (Clinical Trial)
Clinical Trial
OBJECTIVES
The aim of this study was to evaluate the clinical validity of early Sjögren's syndrome (SS) autoantibodies (eSjA), which were originally marketed for early diagnosis of SS, for juvenile SS (JSS) in a recently identified pediatric cohort.
METHODS
A total of 105 symptomatic subjects with eSjA results available were evaluated at the Center for Orphaned Autoimmune Disorders at the University of Florida and enrolled for this study. JSS diagnosis was based on the 2016 ACR/EULAR SS criteria. Demographic/clinical/laboratory parameters were compared between JSS (n = 27) and non-JSS (n = 78) for % positivity, sensitivity, and specificity of eSjA (SP1, anti-salivary protein; CA6, anti-carbonic anhydrase VI; PSP, anti-parotid secretory protein) and classic SS-autoantibodies (cSjA; ANA, SSA/SSB, RF, and others) either alone or in combination. Associations between eSjA and diagnostic/glandular parameters were also determined by Fisher's exact test.
RESULTS
Compared to non-JSS, JSS patients exhibited sicca symptoms demonstrating reduced unstimulated salivary flow rate (USFR) and abnormal glandular features revealed by salivary gland ultrasound (SGUS). Among cSjA, ANA demonstrated the highest sensitivity of 69.2%, while SSA, SSB, and RF showed around 95% specificities for JSS diagnosis. The % positive-SSA was notably higher in JSS than non-JSS (56% vs. 5%). Of eSjA, anti-CA6 IgG was the most prevalent without differentiating JSS (37%) from non-JSS (32%). Sensitivity and specificity of eSjA were 55.6 and 26.9%, respectively. Autoantibodies with potentially applicable specificity/sensitivity for JSS were seen only in cSjA without a single eSjA included. There were no associations detected between eSjA and focus score (FS), USFR, SSA, SGUS, and parotitis/glandular swelling analyzed in the entire cohort, JSS, and non-JSS. However, a negative association between anti-PSP and parotitis/glandular swelling was found in a small group of positive-SSA (n = 19, p = 0.02) whereas no such association was found between anti-PSP-positive compared to anti-PSP-negative. JSS and non-JSS groups differed in FS, USFR, and EULAR SS Patient Reported Index Dryness/Mean in CA6/PSP/ANA, SP1, and SSA-positive groups, respectively. Additionally, a higher FS was found in RF-positive than RF-negative individuals.
CONCLUSIONS
eSjA underperformed cSjS in differentiating JSS from non-JSS. The discovery of clinical impact of eSjA on early diagnosis of JSS necessitates a longitudinal study.
Topics: Adolescent; Adult; Autoantibodies; Child; Child, Preschool; Female; Florida; Humans; Longitudinal Studies; Male; Salivary Glands; Salivary Proteins and Peptides; Sensitivity and Specificity; Sjogren's Syndrome
PubMed: 34249010
DOI: 10.3389/fimmu.2021.704193